scholarly journals De-novo multilayering in fibrovascular pigment epithelial detachment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Manoj Soman ◽  
Jay U. Sheth ◽  
Asmita Indurkar ◽  
Padmanabhan Meleth ◽  
Unnikrishnan Nair
Keyword(s):  
De Novo ◽  
Median Number ◽  
Final Visit ◽  
Low Grade ◽  
Vascular Endothelial ◽  
Pigment Epithelial Detachment ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

AbstractThis study describes the occurrence of multilayered pigment-epithelial detachment (MLPED) as a De-novo phenomenon (DN-MLPED) and compare the features with multi-layering secondary to chronic anti-vascular endothelial growth factor (anti-VEGF) therapy (s-MLPED). We did a retrospective evaluation of spectral-domain optical coherence tomography (SD-OCT) features, treatment-profile, and visual-acuity (VA) outcomes in eyes with MLPED. Out of 17 eyes with MLPED, 7 eyes had DN-MLPED and 10 eyes had s-MLPED. There was no significant difference in baseline and final VA between the groups. At the final visit, no significant visual improvement was noted in both the groups, although a possible trend towards an improvement was seen in DN-MLPED eyes while the s-MLPED demonstrated a declining trend (DN-MLPED—LogMAR-BCVA: Baseline = 0.79 [∼ 20/123] ± 0.91; Final = 0.76 [∼ 20/115] ± 0.73; p = 0.87; s-MLPED—LogMAR BCVA: Baseline = 0.43 [∼ 20/54] ± 0.68; Final = 0.94 [∼ 20/174] ± 0.71; p = 0.06). Moreover, after presentation, the median number of injections in DN-MLPED eyes were significantly lower compared to s-MLPED eyes (DN-MLPED:4; s-MLPED:12; p = 0.03) (Median follow-up: DN-MLPED = 26 months; s-MLPED = 54 months; p = 0.15). Subretinal hyperreflective-material (SHRM) deposition heralded the onset of multilayering and was seen to progress in all DN-PED eyes and 1/4 eyes of s-MLPED. To conclude, MLPED is a unique form of cicatrizing fibrovascular-PED which can evolve denovo too. Long-standing disease with intermittent or low-grade activity can potentially explain this unique phenomenon. With fewer anti-VEGF therapy, the de-novo MLPED eyes show more visual stability as compared to s-MLPED eyes.

scholarly journals De-novo Multilayering in Fibrovascular Pigment Epithelial Detachment

2021 ◽  
Author(s):  
Manoj Soman ◽  
Jay U Sheth ◽  
Asmita Indurkar ◽  
Padmanabhan Meleth ◽  
Unnikrishnan Nair
Keyword(s):  
De Novo ◽  
Median Number ◽  
Final Visit ◽  
Low Grade ◽  
Vascular Endothelial ◽  
Pigment Epithelial Detachment ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract This study describes the occurrence of multilayered pigment-epithelial detachment (MLPED) as a De-novo phenomenon (DN-MLPED) and compare the features with multi-layering secondary to chronic anti-vascular endothelial growth factor(anti-VEGF) therapy(s-MLPED). We did a retrospective evaluation of spectral-domain optical coherence tomography(SD-OCT) features, treatment-profile, and visual-acuity (VA) outcomes in eyes with MLPED. Out of 17 eyes with MLPED, 7 eyes had DN-MLPED and 10 eyes had s-MLPED. There was no significant difference in baseline and final VA between the groups. At the final visit, the DN-MLPED eyes showed improvement in VA (LogMAR-BCVA: Baseline=0.79±0.91; Final=0.76±0.73; p=0.87) while the s-MLPED eyes showed decline (LogMAR BCVA: Baseline=0.43±0.68; Final=0.94±0.71; p=0.87), although not significantly. Moreover, after presentation, the median number of injections in DN-MLPED eyes were significantly lower compared to s-MLPED eyes (DN-MLPED:4; s-MLPED:12; p=0.03) (Median follow-up: DN-MLPED=26months; s-MLPED=54months; p=0.15). Subretinal hyperreflective-material (SHRM) deposition heralded the onset of multilayering and was seen to progress in all DN-PED eyes and 1/4 eyes of s-MLPED. To conclude, MLPED is a unique form of cicatrizing fibrovascular-PED which can evolve denovo too. Long-standing disease with intermittent or low-grade activity can potentially explain this unique phenomenon. With fewer anti-VEGF therapy, the de-novo MLPED eyes show more visual stability as compared to s-MLPED eyes.

Safety of Intravitreal Injection Guide

2017 ◽  
Vol 2 (1) ◽  
pp. 26-31
Author(s):  
Kei Watanabe ◽  
Uematsu Masafumi ◽  
Yasser H. Mohamed ◽  
Takehito Watanabe ◽  
Yusuke Doi ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
University Hospital ◽  
Vascular Endothelial ◽  
Drug Usage ◽  
Anti Vegf ◽  
Systemic Complication ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
Period Data ◽  
Endothelial Growth Factor

Purpose: To evaluate the safety of our developed intravitreal injection guide. Methods: Retrospective review of all case notes for consecutive patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections at the Department of Ophthalmology, Nagasaki University Hospital in Japan between January 2013 and December 2014. We included all patients who had at least 1 intravitreal anti-VEGF injection done within the study period. Data collected included demographics, indications of intravitreal anti-VEGF injections, type of injected drug, usage of intravitreal guide, experience of physicians, and any complication that occurred during or after the procedure. Results: The study included 256 patients (154 males and 102 females) who underwent 992 intravitreal anti-VEGF injections from January 2013 until December 2014. The mean age of the patients was 70.8 ± 11.3 years. Of total injections, 907 (91.44%) were done using the intravitreal guide, 60 (6.04%) were done without using the guide, and only 25 (2.52%) injections were not determined. Local complications include 1 (0.1%) case uveitis, 1 (0.1%) case retinal tear, and 1 (0.1%) case amaurosis fugax. There were no major complications as cataract, retinal detachment, and endophthamitis. No systemic complication was encountered. All complications occurred in the guide group without statistically significant difference in comparison to without guide group ( P = 1.0). All complications were related to experienced group without significant difference in comparison to limited experienced group ( P = .28). Conclusion: We conclude that the process of intravitreal injection with our developed intravitreal injection guide is safe and easy even for limited experienced physicians.

scholarly journals Enlargement rate of geographic atrophy before and after secondary CNV conversion with associated anti-VEGF treatment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakob Siedlecki ◽  
Caroline Koch ◽  
Benedikt Schworm ◽  
Raffael Liegl ◽  
Thomas Kreutzer ◽  
...  
Keyword(s):  
Growth Rate ◽  
Geographic Atrophy ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Before And After ◽  
Endothelial Growth Factor ◽  
Mean Time ◽  
Larger Sample

Abstract Background To study the enlargement rate of primary geographic atrophy (GA) before and after diagnosis of a secondary choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) therapy. Methods Five hundred twenty-two consecutive eyes with primary GA were screened for the development of a complicating secondary CNV. Geographic atrophy was measured on blue autofluorescence (BAF) by two readers and calculated into mean growth rate before and after CNV diagnosis. Results Ten eyes of six patients were included in the study (six study eyes with GA complicated by CNV, four GA only partner eyes). Follow-up was 1.42 ± 0.48 years before and 3.64 ± 2.73 years after CNV. There was no significant difference between mean growth rate before and after CNV (1.58 ± 0.99 vs. 1.39 ± 0.65 mm2/year; p = 0.44) or between study and partner eyes (p = 0.86). Over a mean time of 3.64 ± 2.73 years, a mean of 8.3 ± 2.8 anti-VEGF injections were given. No correlation between the amount of anti-VEGF injections and change in growth rate could be observed (r = 0.58; p = 0.23). Conclusion In this pilot study, primary GA enlargement did not seem to be influenced by a secondary CNV. No association between the intensity of anti-VEGF treatment and changes in atrophy enlargement rates were found. Further studies with larger sample sizes are warranted.

scholarly journals Impact of macular fluid features on outcomes of anti-vascular endothelial growth factor treatment for type 3 macular neovascularization

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wontae Yoon ◽  
Jihyun Yoon ◽  
Seung Kwan Na ◽  
Jihyun Lee ◽  
Jaemin Kim ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Type 3 ◽  
Endothelial Growth Factor ◽  
The Impact ◽  
Anatomical Outcomes

AbstractWe evaluated the impact of macular fluid features on visual and anatomical outcomes in type 3 macular neovascularization (MNV) patients treated with anti-vascular endothelial growth factor (VEGF). We retrospectively enrolled 89 eyes with type 3 MNV with at least 12 months of follow-up. All patients were treatment-naïve and received a monthly loading injection of anti-VEGF for three months, followed by further injections as required. The association of baseline macular morphology, including intraretinal fluid (IRF) and subretinal fluid (SRF), with visual and anatomical outcomes was analyzed. At baseline, IRF was present in all enrolled patients (100%), and SRF was present in 43.8% (39/89) of them. After 12 months of treatment, no significant difference was found in terms of best-corrected visual acuity (BCVA) and changes in central foveal thickness between the eyes with (39) and without (50) SRF at baseline. In addition, the proportion of improved or worsened (gain or loss of more than three lines in the BCVA) visual acuity at 12 months was not significantly different among the groups. Incidence of macular atrophy during the treatment showed no difference between the groups, regardless of the presence of SRF. In conclusion, the macular fluid morphology, specifically SRF, in type 3 MNV showed no significant correlation with visual and anatomical outcomes during anti-VEGF treatment.

Retinal pigment epithelial atrophy after anti-vascular endothelial growth factor therapy for polypoidal choroidal vasculopathy

2020 ◽  
Vol 104 (10) ◽  
pp. 1443-1447 ◽  
Author(s):  
Han Joo Cho ◽  
Kunhae Kim ◽  
Soo Hyun Lim ◽  
Dong Hyun Kang ◽  
Jong Woo Kim
Keyword(s):  
Choroidal Thickness ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Vascular Endothelial ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Rpe Atrophy ◽  
The Mean ◽  
Endothelial Growth Factor ◽  
Choroidal Vasculopathy

Background/aimsTo describe the risk factors for the development of retinal pigment epithelial (RPE) atrophy following intravitreal anti-vascular endothelial growth factor (VEGF) injection treatment for polypoidal choroidal vasculopathy (PCV).MethodsWe retrospectively included 162 eyes of 162 treatment-naïve patients with PCV in this study. All patients were treated with an initial series of three monthly loading doses of anti-VEGF injections, followed by further injections as required. Baseline ocular characteristics and lesion features were assessed using fluorescein angiography, indocyanine green angiography and spectral domain optical coherence tomography, to determine and evaluate the potential risk factors for RPE atrophy through 2 years of follow-up.ResultsRPE atrophy had developed in 17 of 162 eyes (10.5%) after 2 years of anti-VEGF treatment. Nine cases (53.0%) of RPE atrophy occurred at branching vascular networks, and eight (47.0%) developed at locations with polyp or polyp-associated pigment epithelial detachment. Among the baseline characteristics, the mean subfoveal choroidal thickness was significantly thinner (192±98 vs 288±152; p=0.009) and presence of subretinal drusenoid deposits was significantly more frequent in eyes with RPE atrophy (11.8% vs 2.1%; p=0.028). Using multiple logistic regression analysis, the mean subfoveal choroidal thickness (OR 0.975; 95% CI 0.929 to 1.324; p=0.002) was identified as a significant risk factor for the development of RPE atrophy.ConclusionsApproximately one-tenth of the patients with PCV developed RPE atrophy during the 24 months after intravitreal anti-VEGF injections. Subfoveal choroidal thinning at baseline is associated with increased risk of post-treatment RPE atrophy.

scholarly journals Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Masakazu Morioka ◽  
Yoshihiro Takamura ◽  
Kazuki Nagai ◽  
Shigeo Yoshida ◽  
Junya Mori ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
Large Population ◽  
Vascular Endothelial ◽  
Chi Square ◽  
Topical Antibiotics ◽  
Anti Vegf ◽  
Significant Difference ◽  
Chi Square Test ◽  
Endothelial Growth Factor ◽  
Retrospective Multicenter Study

AbstractIntravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.

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